Nursing
Diagnosis: Bathing/hygiene Self-care deficitLinda S. Williams

Defining
Characteristics: Inability to: wash body or body parts; obtain
or get to water source; regulate temperature or flow of bath water; get bath
supplies; dry body; get in and out of bathroom

Impaired physical mobility-functional level classification:0 Completely independent
1 Requires use of equipment or device
2 Requires help from another person for assistance,
supervision, or teaching
3 Requires help from another person and equipment or device
4 Dependent—does not participate in activity

·If
in a typical bathing setting for the client, assess via direct observation
using physical performance tests for ADLs. Observation
of bathing performed in an atypical bathing setting may result in false data
for which use of a physical performance test compensates to provide more
accurate ability data (Guralnik, 1994).

·Develop
a bathing care plan based on client's own history of bathing practices that
addresses skin needs, self-care needs, client response to bathing and equipment
needs. Bathing is a
healing rite and should not be routinely scheduled with a task focus. It should
be a comforting experience for the client that enhances health. (Rader,
Hoeffer, McKenzie, 1996).

·Request
referrals for occupational and physical therapy. Collaboration and correlation of activities with
interdisciplinary team members increases the client's mastery of self-care
tasks (Schemm, Gitlin, 1998).

·Consider
environmental and human factors that may limit bathing ability, such as bending
to get into tub, reaching required for bathing items, grasping force needed for
faucets, and lifting of self. Adapt environment by placing items within easy
reach, lowering faucets, and using a handheld shower. Environmental factors affect task
performance. Function can be improved based on engineering principles that
adapt environmental factors to the meet the client's capabilities (Rogers et
al, 1998).

·Provide
privacy: have only one caregiver providing bathing assistance, encourage a
traffic-free bathing area, and post privacy signs. The client perceives less privacy if more than one
caregiver participates or if bathing takes place in a central bathing area in a
high-traffic location that allows staff to enter freely during care (Miller,
1994).

·Keep
client warmly covered. Clients,
especially elderly clients, who are prone to hypothermia may experience
evaporative cooling during and after bathing, which produces an unpleasant cold
sensation (Miller, 1994).

·Allow
client to participate as able in bathing. Smile and provide praise for
accomplishments in a relaxed manner. The
client's expenditure of energy provides the caregiver the opportunity to convey
respect for a well-done task, which increases the client's self-esteem. Smiling
and being relaxed are associated with a calm, functional client response
(Maxfield et al, 1996).

·Use
or encourage caregiver to use an unhurried, caring touch. The basic human need of touch offers
reassurance and comfort.

·If
client is bathing alone, place assistance call light within reach. A readily available signaling device
promotes safety and provides reassurance for the client.

Geriatric

·Provide
same type of bathrobe and bathing articles, such as scented dusting powder and
bath oil, that client used previously. Use
of sensory channels to stimulate memory may help foster understanding of
bathing and self-care (Danner et al, 1993).

·Assess
for grieving resulting from loss of function. Grief resulting from loss of function can inhibit
relearning of self-care.

·Allow
client or caregiver adequate time to complete the bathing activity. Significant aging increases the time
required to complete a task; therefore elderly individuals with a self-care
deficit require more time to complete a task.

·Avoid
soap or use only mild soap on genital and axillary areas; rinse well. Soap can alter skin pH and thus skin
defenses, and it may increase skin dryness that results from decreased oil and
perspiration production in the elderly (Skewes, 1997).

·Use
tepid water: test water temperature before use with a thermometer. Hot water promotes skin dryness and
may burn a client with decreased sensation.

·Use
a gentle touch when bathing; avoid vigorous scrubbing motions. Aging skin is thinner, more fragile,
and less able to withstand mechanical friction than younger skin.

·Add
hydrating bath oils to tub bath water 15 minutes after client immerses in
water. Client's skin is
coated with oil rather than being hydrated if bath oil is placed in water
before client's skin is moistened with water (Skewes, 1997).

Home Care Interventions

·Based
on functional assessment and rehabilitation capacity, refer for home health
aide services to assist with bathing and hygiene. Support by home health aides preserves the energy of
the client and provides respite for caregivers.

·Cue
cognitively impaired clients in steps of hygiene. Cognitively impaired clients can successfully
participate in many activities with cueing, and participation in self-care can
enhance their self-esteem.

·Respect
the preference of terminally ill clients to refuse or limit hygiene care. Maintaining hygiene, even with
assistance, may require excessive energy demands from terminally ill clients.
Pain on touch or movement may be intractable and not resolved by medication.

·If
a terminally ill client requests hygiene care, make an extra effort to meet
request and provide care when client and family will most benefit (e.g., before
visitors, at bedtime, in the early morning). When
desired, improved hygiene greatly boosts the morale of terminally ill clients.

·Maintain
temperature of home at a comfortable level when providing hygiene care to
terminally ill clients. Terminally
ill clients may have difficulty with thermoregulation, which will add to the
energy demand or decrease comfort during hygiene care.

Client/Family Teaching

·Teach
client and family how to use adaptive devices for bathing, and teach bathing
techniques that promote safety (e.g., getting into tub before filling it with
water, emptying water before getting out, using an antislip mat, wall-grab
bars, tub bench). Adaptive
devices can provide independence, safety, and speed (Schemm, Gitlin, 1998).

·Teach
client and family an individualized bathing routine that includes a schedule,
privacy, skin inspection, soap or lubricant, and chill prevention. Teaching methods to meet client's
needs increases the client's satisfaction with the bathing experience.